https://orcid.org/0000-0001-5195-3504
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Abstract
Background
Chronic idiopathic constipation (CIC) is a functional gastrointestinal disorder with an estimated prevalence of 16% in the USA; however, the humanistic and economic burden of CIC is poorly characterized.
Aim
This systematic literature review aimed to assess the humanistic and economic burden of CIC in adults in the USA.
Methods
Two systematic literature searches of English-language publications on the humanistic and economic burden of CIC in adults in the USA were conducted using electronic databases and other resources. Both searches included the terms “chronic idiopathic constipation” and “functional constipation”. Specific terms used in the search on humanistic burden included “quality of life”, “SF-36”, “SF-12”, and “PAC-QOL”; search terms for economic burden included “cost”, “resource use”, “absenteeism”, and “productivity”.
Results
Overall, 16 relevant articles were identified. Health-related quality of life (HRQoL) appeared to be reduced in patients with CIC compared with controls and the general US population. Abdominal (r=0.33–0.49), stool (r=0.23–0.33), and rectal symptoms (r=0.53) appeared to be associated with reduced HRQoL. Younger age and female sex were associated with reduced overall HRQoL and greater symptom severity. Direct outpatient costs were higher in patients with CIC than those without CIC (US$6284 vs US$5254). Patients with CIC and abdominal symptoms reported more days of disrupted productivity per month than those without abdominal symptoms (3.2 days vs 1.2 days). The overall prevalence of complementary and alternative medicine use by patients with CIC was similar to that in the general US population.
Conclusion
The reduced HRQoL and increased costs associated with CIC indicate unmet therapeutic need in this disorder. Further research is required to better understand the humanistic and economic burden of CIC in the USA.
Abbreviations
CAM, complementary and alternative medicines; CIC, chronic idiopathic constipation; CTT, colonic transit time; EMR, electronic medical records; ER, emergency room; FC, functional constipation; GI, gastrointestinal; HCRU, healthcare resource utilization; HMO, health maintenance organization; HRQoL, health-related quality of life; IBS-C, inflammatory bowel syndrome with constipation; MCS, mental component summary; NHP, Nottingham Health Profile; OMT, osteopathic manipulative treatment; PAC-QOL, Patient Assessment of Constipation Quality of Life questionnaire; PAC-SYM, Patient Assessment of Constipation Symptoms questionnaire; RCT, randomized controlled trial; SF-12, 12-item Short-Form Health Survey; SF-36, 36-item Short-Form Health Survey; SLR, systematic literature review.
Acknowledgments
Medical writing support was provided by Emma Saxon PhD of PharmaGenesis London, London, UK, with funding from Shire, a member of the Takeda group of companies. An abstract presenting the economic burden of chronic idiopathic constipation was presented at the Digestive Disease Week 2018 and at the Academy of Managed Care Pharmacy 2019 as poster presentations. These abstracts were published in Gastroenterology: [https://doi.org/10.1016/S0016-5085(18)32625-8] and Journal of Managed Care & Specialty Pharmacy: [https://doi.org/10.18553/jmcp.2019.25.3-a.s1], respectively. In addition, an abstract presenting the health-related quality of life of chronic idiopathic constipation was presented at the American College of Gastroenterology 2018 and at the Academy of Managed Care Pharmacy 2019 as poster presentations. These abstracts were published in the American Journal of Gastroenterology: [https://doi.org/10.1038/s41395-018-0293-3] and Journal of Managed Care & Specialty Pharmacy: [https://doi.org/10.18553/jmcp.2019.25.3-a.s1], respectively.
Author Contributions
All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
AN is an employee of Shire, a member of the Takeda group of companies and has received stock from Takeda. SM is an employee of RTI Health Solutions, Ann Arbor, MI, USA. OO-A, DM, and MP are employees of RTI Health Solutions, Durham, NC, USA. RMV is an employee of RTI Health Solutions, Manchester, UK. RTI Health solutions received financial support from Shire Development LLC, a member of the Takeda group of companies for participation in the study design, data analysis, and data interpretation. The authors report no other conflicts of interest in this work.